Recognizing Variations in Primary Palatoplasty Billing: A Review of 9827 Cases

ObjectiveIdentify unbundling trends in primary palatoplasty.DesignRetrospective study utilizing the American College of Surgeon Pediatric National Surgical Quality Improvement Program (PNSQIP).SettingRecords available from 2016 to 2021.PatientsAll patients with primary CPT (current procedural terminology) code 42200 (palatoplasty for cleft palate, soft and/or hard palate only).InterventionsCohorts compared "unbundled": additional CPT code 42235 (repair of anterior palate, including vomer flap) vs. "bundled": 42200 billed alone.Main outcome measuresOperative time, surgical specialty, and other perioperative variables.ResultsIn total, 9827 had primary CPT 42200. Of these, 671 (6.8%) were unbundled. Operative time was longer in unbundled (157.08 min vs. 133.16 min; P < .001). Plastic surgeons were less likely to unbundle (6.2% vs. otolaryngology, 9.12%; P < .001).ConclusionsVariations in primary palatoplasty billing exist. Longer operative times in unbundled cases suggest added complexity. Undervaluation of craniofacial CPT codes may contribute to non-standard billing practices.